Neuro and optho Uworld Flashcards
1
Q
lacunar infarct causes what
A
pure unilateral motor impairment
pure sensory stroke
no visual field abnormalities
2
Q
middle cerebral a occlusion signs
A
contra somatosensory loss contra motor loss
conjugate eye deviation toward infarct side
homonymous hemianopia
aphasia (if left hemisphere aka dominant)
hemineglect of the non dominant hemisphere (right)
3
Q
anterior cerebral artery occlusion signs
A
contra somatosensory and motor deficit
mainly in lower legs
dyspraxia, emotional disturbances and urinary incontinence
4
Q
most common cuases syringomyelia
A
spinal cord injury and arnold chiari malformations
5
Q
what nerve controls hip and knee flexion
A
femoral
6
Q
what causes intracranial HTN
A
trauma, space occupying lesions, hydrocephalus, impaired CNS venous outflow and idiopathic(pseudotumor cerebri)
7
Q
patient with otitis and now mastoiditis, next step?
A
Brain CT to look for brain abscess, likely temporal
8
Q
what type of neuronal signs in ALS
A
upper and lower
9
Q
symptoms and signs of friedreich ataxia
A
necrosis and degeneration cardiac muscle fibers, myocarditis, myocardial fibrosis, cardiomyopathy
T wave inversion
10
Q
T wave inverison alone is suggestive of what pathologie
A
myocarditis, MI, old pericarditis, Myocardial contusion and dig toxicity
11
Q
what can cause carotid artery dissection
A
penetrating trauma
fall with object in mouth
neck maniputlation (yoga and sports)
12
Q
personality change means that what lobe is affected
A
frontal
13
Q
CT/MRI findings glioblastoma
A
butterfly appearance with central necrosis
14
Q
what happens with prolonged seizures
A
cortical laminar necrosis
15
Q
pronator drift is sensitive and specific for what
A
UMN injury
16
Q
main risk factory for CP
A
prematurity
17
Q
phenytoin use during pregnancy, child will have
A
fetal hydantoin syndrome
midfacial hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsutism and developmental delay
18
Q
Aminoglycoside adverse effect
A
ototoxicity
19
Q
what is used for absence seizures
A
ethosuximide and valproic acid
20
Q
shakey baby syndrome will cause what inside
A
shearing subdural veins and retinal hemorrhages
21
Q
course of presentation for intracerebral hemorrhage
A
focal neurologic symptoms early
later develop nausea and vomiting from ICP
22
Q
brain death, still have preserved what function sometimes
A
DTRs
23
Q
what dementia can cause visual hallucinations
A
lewy body
24
Q
multuple circumscribed lesions on both sides of brain along junction grey and white matter
A
secondary mets
likely lung or melanoma
25
solitary brain masses are usually from what CA
breast, colon or renal cell
26
what is primidone used for
essential tremor
| it converts into phenylethylmalonamide and phenobarbital
27
primidone may precipitate what
acute intermittent porphyria
28
how does acute intermittent porphyria present
abdominal pain, neuro and psychiatric abnormalities
29
how do Dx acute intermitten porphyria
check for urine porphobilinogen
30
Tx viral conjunctivitis
cool moist compresses
31
immediate manamgent of central retinal artery occlusion
ocular massage and high flow O2
32
Tx exertional heat stroke
immersion in ice water after stabilized with IV fluids
33
what are signs of uncal herniation
compression of contralateral crus cerebri causes ipsi hemiparesis
compression ipsi occulomotor nerve cause mydriasis ptosis and down out gaze
compression ipsi posterior a causes contralateral homonymous hemianopsia
compression reticular formation will cause LOC and coma
34
transtentorial uncal herniations can be secondary to what
space occupying lesions like epidural bleed
35
cushings reflex
HTN bradycardia and respiratory depression all from increased ICP
36
findings on MRI of meningioma
extra-axial well circumscribed and homogenously enhancing dural based mass
37
signs of niemann pick
loss of motor milestones, hypotonia, feeding difficulties cherry red macula
!! different the tay sachs because also will have hepatosplenomegaly and Areflexia
tay sachs has hyperreflexia
38
niemann pick is deficiency in what
spingomyelinase
39
next step for enlarging head circumference in child
CT of brain
40
complications of prematurity
```
RDS
PDA
bronchopulmonary dysplasia
intraventricular hemorrhage
necrotizing enterocolitis
retinopathy
```
41
NPH is due to
decreased CSF absorption
42
how to check for phenylketonuria
quantitative aa analysis
| or tandem mass spectrometry
43
signs phenlyketouria
severe intellecual disability
seizures
musty odor
hypopigmentation involing hair skin eyes and brain nuclei
44
incidence of Intraventricular hemorrhage is inversely proportional to what
birth weight
45
first line for migraines assoc with vomiting
prochloperazine (antiemetic)
46
presence of EBV DNA in CSF
primary CNS lymphoma
47
MRI of CNs lymphoma
ring enhancing mass that is solitary and periventricular
48
wallenberg syndrome
vertigo, fall to side of lesion
diplopia and nystagmus
ipsi limb ataxia
abnormal facial sensation or pain
loss of pain and temp ipsi face contra trunk and limbs
```
dysphagia and aspiration
hoarseness
ipsi horners
intractable hiccups
lack of automatic respiration
```
49
what artery occlusion causes wallenbergs
intracranial vertebral artery
50
side effects trihexyphenidyl
anticholinergic: blurred vision, constipation, vomiting
| headache, dizziness, tachycardia
51
Tx myasthenic crisis
plasma exchange
52
CMV retinitis signs
yellow whiteish patches retinal opacification and retinal hemorrhages
53
Tx CMV retinits
ganciclovir or foscarnet
54
presentation sturge weber
focal or generalized seizures, mental retardation and port wine stain along trigeminal nerve
can have hemianopia, hemiparesis and hemisensory disturbances
55
intracranial calcifications resembling tramline
sturge weber
56
bilateral loss central vision
macular degeneration
57
HTN hemorrhage with contralateral hemiparesis and hemianesthesis and conjugate gaze deviation to side of lesion
putamen (basal ganglia bleed) because affects internal capsule
58
effects of parietal hemorrhage
contralateral hemi sensory loss
59
Cauda equina syndrome
compression spinal nerve roots from metastatic prostate CA
can lose anal sphincter innercation, lose parasympathetic to bowel and bladder
LMN Sx
60
conus medullaris syndrome
sudden onset with severe back pain and have hyperreflexia
61
signs hypokalemia
weakness, fatigue, muscle cramps
flaccid paralysis hyporeflexia, tetany and rhabdomyolysis
EKG shows broad T waves and U waves, ST depression and PVC
62
periodic sharp waves on EEG
prion disease
63
rapidly progressing dementia and myoclonus
prion disease
64
gradually worsening severe low back pain that is worse at night laying down and have symmetric weakness with absent DTRs early on. later develop hyperreflexia and babinski
spinal cord compression
65
Tx spinal cord compression
EM MRI
IV glucocorticoid
rad/onc or neurosurg consults
66
first line for alzheimers
cholinesterase inhibitors like donepezil, galantamine, rivastigmine
67
what is sympathetic opthalmia
immune mediated inflammation of one eye after penetrating injury to other. "uncover hidden Ag"
68
Shy Drager syndrome
multiple system atrophy
| parkinsonism, autonomic dysfunction and widespread neurologic signs including cerebellar, pyramidal and LMN
69
patient with parkinsonism has othostatic hypotension incontinence and other ANS Sx
suspect shy drager
70
infant with fialure to thrive, bilateral cataracts jaundice an dhypoglycemia
Galactose 1 phosphate uridyl transferase deficiency aka Galactossemia
71
patient with galactossemia are at increased risk for what
E coli neonatal sepsis
72
gradual loss peripheral vision
open angle glaucoma
73
atrophy caudate
huntingtons
74
baby crying goes pale and passes out
breath holding spell, normal in 6 mo - 2 yr
75
side effect expected early on after initiation levodopa/carbidopa
hallucinations and dyskinesia
76
amantadine side effects
ankle edema and livedo reticularis
77
Wernicke encephalopathy
encephalopaty, ocular dysfunction, gait ataxia
| from alcohol
78
Tx wernicke
thiamine and glucose
79
drug for trigem neuralgia
carbamazepine
80
prophylaxis for cluster HA
verapamil, lithium, and ergotamine
81
treatment for acute cluster HA
100% O2 and subcutaneous sumatriptan
82
transient pain in right UE and LE. right hemianesthesia, mild athetosis right hand
strength is preserved in all 4
lesion is where?
thalamus "thalamic pain phenomenon"
83
Tx for migrain in children
supportive like laying in dark and then administration of acetominophen or NSAID
84
gonococcal conjunctivitis
copious exudates and eyelid swelling at age 2-5
85
Tx gonococcal conjunctivitis
hospitalization
| dose of ceftriaxone or cefotaxime
86
NF1 characteristics
cafe au lait spots, macrocephaly, feeding problems, short stature and learning disabilities
87
acute ischemic stroke, hemorrhage rule out, next step?
fibrinolytic therapy if within 3-4.5 hours
88
Leschy nyhan mutation
x linked recessive. hypoxanthin guanin phosphoribosyl transferase
89
glucocorticoid induced myopathy
progressive muscle weakness and atrophy without pain
| lower extremity more common
90
arm helf in external rotation cannot internall rotate
axillary nerve damaged
91
triad epidural abscess
fever, severe focal back pain and neuro deficits
| progressive symptoms of radiculopathies and motor/sensory deficits
92
Dx spinal epidural abscess
MRI spine with gadolinium
93
Tx spinal epidural abcess
immediate surgical decompression
94
what pathogen is assoc with guillain barre
Campylobacter jejuni
95
high velovit injury to the high has a higher probability for what
globe penetration an intraocular foreign body so use fluorescein to look
96
causes of delerium
```
drugs
infection
electrolytes
metabolic derrangments
systemic illness
CNS
```
97
Sx of facial palsy upper and lower
cannot do brow movements
| cannot close eyes
98
visual hallucinations are in what dementia
lewy body
99
what is trachoma
caused by chlamydia trachomatis, cuase blindness worldwide
100
sigsn trachoma
follicular conjunctivitis and pannus(neovascularization) in cornea
101
Tx trachoma
topical tetracycline and oral azithromycin
102
acute angle closure
more common in asian women
severe eye pain with halos around lights
pupil is dilated and poorly responds to light
HA with nausea and vomiting
103
Tx pseudotumor cerebri
acetazolamide is first line
| inhibits choiroid plexus carbonic anhydrase
104
diffuse cortical and subcortical atrophy in temporal and parietal lobes
alzheimer
105
Dx vasospasm post subarachnoid hemorrhage
CTA
106
how to prevent vasospams post subarachnoid hemorrhage
nimodipine
107
tremor in parkinsons
4-5 Hz. better with intention. resting tremor
108
straight lines now appear wavy
macular degeneration
109
HIV patient with ekratitis fundoscoy show pale peripheral retinal lesions and central necrosis of retina
Herpes simplex
110
most common predisposing factor to orbital cellulitis
bacterial sinusitis
111
signs orbital cellulitis
proptosis, ophthalmoplegia and diplopia
112
affect of young child with meningtisi
regression of milestones
113
most common cause lumbar spine stenosis
degenerative joint disease
114
signs lumbar spine stenosis
worse when walking downhill because extends spine. weakness, senory loss, numness
confirm by MRI
115
male with sudden onset red left eye with photophobia nausea and severe HA. no trauma. nonreactive mid dilated left pupil
acute angle closure glaucoma
116
what medication can precipitate acute angle closure
decongestants
117
trigem neuralgia is common in what population
women with MS
118
sensory of cornea is innervated by
trigeminal nerve, V1
119
pathogens causing brain abscesses
strep viridans
staph aureus
gram negative
120
solitary ring enhancing lesion on brain CT with fluid collection in ethmoid sinus
brain abscess
121
why are patients with Digeorge higher risk brain abscess
have the VSD which provides access to brain arterials without going through lung first, escaping lung mechanisms to rid infections and pathogens.
if vignette says child with multiple sinusitis, suspect brain abscess
122
auras are indicative of what type seizure
focal area so partial seizure
123
complex partial seizure
automatisms with the LOC
124
partial seizure iwth secondary generalization
tonic clonic manifestations like diffuse muscle aches and elvated CPK
125
treatment trigeminal neuralgia
carbamazepine
126
adverse effect carbamazepine
aplastic anemia, need routine CBC
127
Fetal alcohol syndrome characteristics
small palpebral fissures
smooth philtrum
thin vermilion border
can have microcephaly
128
long narrow face, prominent forehead and chin
large ears
macrocephaly
macroorchidism
fragile X syndrome
129
causes of hemiplegia in children
seizure, intracranial hemorrhagic, ischemic stroke, hemiplegic migraine
130
Signs craniopharyngioma
remnants of rathke pouch
can cause bitemporal hemianopsia
can cause endocrinopathies from compression pituitary stalk
suprasellar calcified mass on imaging
131
what is opthomalogic manifestation NF1
optic glioma
132
gait distrubance with medulloblastoma
truncal ataxia
133
bitemporal hemianopsia and decreased libido
likely craniopharyngioma
134
Tx restless leg syndrome
first line is dopamine agonist pramipexole
| alternate is alpha 2 delta Ca channel ligands like gabapentin
135
presbyopia
loss of lens elasticity
| needed to focus on near objects
136
DM II with fatigue urinary frequency and increased blurry vision and leg cramps. all after respiratory infection. high BP. dry mucous membranes urine + glucose negative for ketones
whats causing vision blurriness?
hyperosmolarity from non ketotic hyperglycemia causing osmotic diuresis and dehydration
137
postconcussive syndrome
HA confusion, amnesia, difficulty concentrating with multitasking, vertigo, mood alteration, sleep disturbance and anxiety
138
side effect metoclopramide
dystonic reaction because it is a dopamine R antagonist
| can cause agitation, tardive dyskinesia and dystonic reactions and parkinsonism
139
how to counteract dystonic reaction from metoclopramide
benztropine or diphenhydramine
140
basal ganglia hemorrhage signs
contralateral hemiparesis and hemisensory loss
homonoymous hemianopsia
gaze palsy
141
thalamus hemorrhage signs
contra hemiparesis and hemi sensory
nonreactive miotic pupils
upgaze palsy
eyes deviate towards hemiparesis
142
pinpoint reactive pupils. where is hemorrhage
pons
143
most common etiology of basal ganglia hemorrhage
HTN vasculopathy
144
best Dx acoustic neuroma
MRI with gadolinium
145
homocystinuria
```
intellecual disability
thrombosis
megaloblastic anemia
fair complexion
tall stature
join hyperlaxity
scoliosis
```
146
What is mechanism of diabetic oculomotor nerve neuropathy
ischemic of the somatic fibers, does not affect parasympathetic so reactive to light still
147
conjuctival appearance in allergic conjunctivits
follicular or bumpy conjunctival edema (chemosis)
148
lacunar strokes affect what areas
basal ganglia
internal capsule
pons
149
risk factor lacunar strokes
HTN
DM smoking, age, and high LDL
cause lipohyalinosis
150
painful eye with very red sclera and opacification and ulceration of the cornea
contact lens assoc keratitis
usually due to pseudomonas and serratia
medical EM
151
Tx pseudomonal keratitis
topical broad spectrum antibiotics
152
Anterior cord syndrome
burst fracture in vertebrae
lose motor below and loss pain and temp on both sides below lesion
get MRI
153
NF patient with HA nausea and vomiting. next step
order brain and orbital MRI
154
another name for vasovagal syncope
neurocardiogenic
155
loss of conjugate gaze
MLF disruption
156
what meds can cause pseudotumor cerebri
hypervitaminosis A (acne)
157
most important risk factor for stroke
HTN >smoking
158
central cord syndrome
weakness in UE more than lower. selective loss of pain and temp in arms from damage to spinothalamic tract
159
type of injury for central cord syndrome
hyperextension
160
mutation in fragile X
CCG repeats causing abberant methylation
161
what is maintained in anterior cord syndrome
position vibration and touch
162
LP results in GBS
increased protein. normal everything else
163
what causes decreased glucose in LP analysis
bacterial meningitis or TB meningitis
164
what is pathology benight paroxysmal positional vertigo
crystalline deposits in semicircular canals that disrupt flow
165
Lambert Easton
autoAb against voltage gated Ca Ch in presynaptic motor nerve terminal, defective release Ach
166
tick borne paralysis
rapidly progressive ascending paralysis, can be asymmetrical and there are no sensory abnormalities and CSF is normal
167
complication of untreated pseudotumor cerebri
blindness
168
chalazion
painful swelling progress to nodular rubbery lesion
169
recurrent chalazion, next step
histopath examination
170
finding on patient with alcoholic cerebellar degeneration
gait dysfunction, truncal ataxia, nystagmus and intention tremor or dysmetria
171
pain and decreased visual acuity post cataract surgery
postop enopthalmitis
| need humor sent for culture and gram stain
172
patient falling toward side of lesion
cerebellar tumor
173
2 year old with fever, irritability and lethargy, intermittend abdominal discomfort and losing weight. firm nodular mass in right flank with no bruits
multiple calcifications in renal area and increased homovanillic and VMA
neuroblastoma from neural crest cells
174
mets of neuroblastoma
bones, skull bone marrow liver, lymph nodes and skin
175
fundoscopy shows zones of whitened edematous retina and disctribution of retinal arterioles
displaced retinal embolus
176
Von Gierkes
glucose 6 phosphotase deficiency, type I glycogen storage disease
177
Sx von gierkes
hypoglycemia and lactic acidosis
hyperuricemia
hyperlipidemia
doll like face, thin extremities and short stature with protuberant abdomen
178
vitreous hemorrhage
sudden loss of vision and floaters. from diabetic retinopathy
loss of fundus details, and dark red glow
179
lab value increase in Vit B12 deficiency
methylmalonic acid
180
swelling over one cranial bone post birth with no discoloration
cephalohematoma
181
diffuse bruised swelling of newborn scalp
caput succedaneum
182
first line for acute angle closure glaucoma
mannitol IV
183
how does pilocarpine decrease inraocular P
open canals of schlemm to allow drainage
184
how dose timolol help IOP
decrease production aqueous humor
185
most common adult onset muscular dystrophy
steinert disease. musc dystrophy type 1
186
mutation in aduld onset musc dystrophy
auto dominant
| CTG trinucelotide repease in DMPK gene on chrom 19q
187
signs of sadult onset musc dystrophy
facial weakness, weak handgrip
myotonia and dysphagia
testicular atrophy
188
inheritance duchenne and becker
x linked recessive
189
onset musc dystrophy age 2-3
duchenne
190
onset musc dystrophy age 5-15
becker
191
girl recently brok up with bF and passes out. slightly disoriented after
seizure. not syncope
192
what is riluzole
glutamate inhibitor used in ALS
193
NF2 mutation
chrom 22. nonsense of tumor supressor gene
194
wilsons disease labs
elevated LFTs
| low ceruloplasm
195
signs of wilsons
tremor, rigidity, depression, paranoia, catatonia
196
insect bite to cheek. now both eyes swollen, no appetite, vomiting with fever. erythema and EOM restricted
tender to palpation over forehead
cavernous sinus thrombosis
197
dacrocystitis
infection lacrimal sac
198
changes in color perception. pain on eye movement
optic neuritis
199
psuedodementia
seem severely depressed without memory loss
